Efficacy of Esophagectomy Following Neoadjuvant Chemotherapy for Esophageal Neuroendocrine Carcinoma.

BACKGROUND/AIM: Esophageal neuroendocrine carcinoma (E-NEC) is a rare malignancy. Although treatment for E-NEC involves a combination of surgery, chemotherapy, radiotherapy, and immunotherapy, E-NEC prognosis is poor and the treatment strategy remains unclear. Surgery after neoadjuvant chemotherapy is the standard treatment for advanced esophageal squamous cell carcinoma; however, limited reports exist on its application for E-NEC. This study aimed to examine the surgical outcomes of patients with E-NEC based on the pathological findings of endoscopic biopsies before surgery and surgical specimens.

PATIENTS AND METHODS

We examined patients who underwent thoracoscopic subtotal esophagectomy for esophageal or esophagogastric junction cancer and were diagnosed with E-NEC based on endoscopic biopsy or surgical pathology.

RESULTS

This study included 12 patients. Preoperative endoscopic biopsy confirmed a diagnosis of E-NEC in five patients. Six patients had a mixture of squamous cell carcinoma and NEC components (including suspected cases), and one patient had adenocarcinoma. Neoadjuvant chemotherapy was administered to 10 patients, including four who received 5-fluorouracil with cisplatin, three who received etoposide with cisplatin, two who received etoposide with carboplatin, and one who received S-1 with oxaliplatin. R0 resection was performed through thoracoscopic esophagectomy. Histopathological diagnosis after surgery identified NEC in eight patients, a mixed type in three patients, including MiNEN in two patients, and SCC in one patient. Recurrence occurred within one year in seven patients, and three of these patients died within one year due to hematogenous metastasis. The one-year overall survival rate was 67% (9/12 cases), and the median survival time was 41.7 months.

CONCLUSION

Esophagectomy combined with preoperative chemotherapy for E-NEC may contribute to improved prognosis.